胃癌侵犯胰腺的诊断与治疗

目的：探讨胃癌侵犯胰腺的术前诊断方法及其手术治疗价值。方法：对420例胃癌患者术前行电子胃镜和（或）内镜超声检查、上腹部B超和（或）螺旋CT扫描，术前检测血清肿瘤相关抗原CEA、CA19－9、CEA72－4水平。所有病例均接受外科手术，术中及术后病理证实胃癌侵犯胰腺者共62例，其中行联合腺切除的胃癌根治术37例，非根治术25例。结果：内镜超声、CT扫描和B超检查对胃癌侵犯胰腺的术前诊断率分别为84．2％、57．1％和25．8％。联合胰切除的根治手术组与非根治手术组比较，两组的生存期差异有显著性意义（P＜0．05）。结论：内镜超声和CT扫描对胃癌侵犯胰腺的术前诊断有较大的帮助。联合胰腺切除的胃癌根治术可延长部分病例的生存期。

Diagnosis and surgical management of advanced gastric cancer with pancreatic invasion

Objective To study preope rative diagnosis of advanced gastric cancer (AGC) with pancreatic invasion and their value of surgical management. Methods 420 patients with AGC were estimated preoperatively by electronic gastroscope and/or endoscopic ultrasound(EUS), epigastric B ultrasound (BUS) and/or spi ral CT scan. Serum tumor related antigens including CEA, CA19 9 and CA72 4 were detected preoperatively. Sixty two (14 8%) out of 420 AGC patients with p ancreatic invasion were confirmed by intraoperative and postoperative pathologic al diagnosis. Of these, 37 patients underwent simultaneous pancreatectomy combin ed with gastric cancer radical operation, 25 underwent non radical intervention . Results The diagnosis rate of EUS, spiral CT scan and BUS in patients with AGC with pancreatic invasion preoperatively was 84 2%, 57 1% and 25 8%, respectively. The 1 , 3 , and 5 year survival rat e of patients with pancreatic invasion was 55 8%, 23 0% and 6 4%, respectivel y. There was a significant difference between the survival rate of patients who underwent radical operation ombined with simultaneous pancreatectomy and non ra dical intervention ( P <0 05). Conclusions EUS and spiral CT scan are helpful in the preoperative diagnosis of AGC with p ancreatic invasion. The active surgical management of AGC with pancreatic invasi on is advisable, which can improve the survival of some patients.